Footwear and Foot Orthoses For Elsevier Commissioning Editor: Sarena Wolfaard/Rita Demetriou-Swanwick Development Editor: Nicola Lally Project Manager: Sruthi Viswam Designer/Design Direction: Stewart Larking Illustration Manager: Gillian Richards Illustrator: Cactus Footwear and Foot Orthoses Dr Anita Williams PhD BSc(Hons) FCPodM – Directorate of Prosthetics, Orthotics and Podiatry, University of Salford, Salford, UK Professor Chris Nester PhD BSc(Hons) Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Salford, UK Series Editor Ian Mathieson BSc(Hons), PhD, MChS Senior Lecturer, Wales Centre for Podiatric Studies, University of Wales Institute, Cardiff, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2010 © 2010 Elsevier Ltd. All rights reserved. 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ISBN 978 0 7020 3042 0 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notices To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Working together to grow libraries in developing countries The www.elsevier.com | www.bookaid.org | www.sabre.org publisher’s policy is to use paper manufactured from sustainable forests Printed in China Foreword Welcome to ‘Footwear and Foot Orthoses’, the 3rd volume in the Pocket Podiatry series. This volume is included in recognition of our evolving understanding of the true role of footwear in the maintenance of foot health and the management of foot pathology. Whilst it is tempting to say that Podiatrists have always appreciated the impact of footwear on foot health and disease, the reality is perhaps a little different. A historical emphasis on footwear as a cause of foot pathology may have been derived not from detailed knowledged of its role, but rather due to a limited understanding of other influences – most notably biomechanics. Develop- ing knowledge of biomechanics identified what seemed to be the real cause of foot pathology, which perhaps then had the effect of somewhat marginalising the role of footwear as clinicians focused on orthoses to modify foot and lower limb biomechanics: the ‘real’ cause of pathology. We are now appreciating the reality that whilst foot and lower limb bio- mechanics provides us with detailed information on lower limb function, and orthoses provide an important means of addressing biomechanical dysfunction, footwear too is vital and the interaction between these three factors must be appreciated. In this volume Dr. Williams and Professor Nester do an excellent job of reconciling these three elements in a clinically relevant manner, providing insight to our contemporary knowledge and understanding of foot function, footwear, and orthoses. They do so in an objective and informative manner that reflects the experience and knowl- edge gained from research efforts spanning many years in what is a world-class research facility at the University of Salford. In common with the preceding two volumes I enjoyed being involved with this project, and draw your attention to two important highlights: firstly, Professor Nester’s clinically-oriented synthesis of his wide-ranging research programme that is attempting to uncover the secrets of the mul- tiple functional segments of the foot that have for so long been regarded as of limited importance; secondly, in addition to providing information on the basics of specialist footwear, Dr Williams provides insight to a variety of clinical issues that are vital to successfully utilise this important thera- peutic modality. I am grateful to them for undertaking the task of producing this volume and hope that, armed with the information contained within it, you are better prepared than ever to tackle the complex issues surround- ing footwear and orthoses that we must deal with on a daily basis. Ian Mathieson, Cardiff, 2010 Preface The importance of footwear is inescapable as it features in all aspects of our lives, work, sport and recreation, and social activities. Most of us have many pairs of shoes for different purposes and for different outfits, though maybe not as many as Imelda Marcos, who is reported to have said about her own extravagancy and obsession with footwear: “I did not have three thousand pairs of shoes; I had one thousand and sixty.” Footwear has an impact on foot health and this impact can be nega- tive, such as incorrect footwear causing skin and structural foot problems, or positive as correct footwear can contribute to good foot health. It is the role of podiatrists and other practitioners who care for the foot, to provide advice on the suitability of footwear for a person presenting with foot problems and with consideration to their personal needs and choices. As an addition to footwear, foot orthoses (insoles) can improve foot function and foot health and are provided by clinicians for people with a variety of lower limb pathologies. These pathologies may originate from functional problems, such as flat feet, or from systemic problems, such as deformity associated with diabetes or rheumatoid arthritis, and of course there may be a combination of functional and systemic problems. Foot orthoses are worn in footwear, therefore consideration to the foot- wear suitability is crucial to the success of the orthoses. As the authors of this Pocket Guide, we aim to provide the practitioner with the knowledge to enable them to maximize the potential for footwear to have a positive impact on foot health, with or without foot orthoses. To achieve this aim, practitioners need to have an understanding of the components of footwear in relation to its fit, suitability and function. As footwear is considered by our patients to be an item of clothing, an understanding of patients’ perceptions of footwear in relation to body image is crucial, as is knowledge and skill in supporting behaviour change with footwear choices. The perception of footwear as a vital part of body image is entrenched in its social role throughout history, therefore the development of footwear design and purpose will be explored in this context. Footwear and foot orthosis design and manufacture is a developing area. With technological advances in manufacture and design, the prac- titioner is able to guide patients to the footwear that will promote good foot health. Alongside this is a requirement for the practitioner to have an understanding of footwear issues in relation to the healthy and vulnerable foot, ensuring that evidence is continuously embedded in clinical practice. To this end, the content of this book is based on best available evidence. With the scale of foot problems in relation to chronic diseases and a growing, aging population, it has never been more essential to maintain and improve foot health. Good foot health is seen as one of the key areas in achieving good mobility and levels of activity and these in turn support the maintenance of a healthy body. Foot orthoses and footwear therefore play a vital role in the achievement of good health. Dr Anita Williams and Professor Christopher Nester Salford 2009 Acknowledgements Rebecca Shawcross, Northampton Museums and Art Gallery, Guildhall Road, Northampton, NN1 1DP for supplying images for Chapter 4 Neville Rowlands, Reed Medical, Blackburn, Lancashire, United Kingdom, BB1 2QQ for his support and professional advice on Chapter 5 and Chapter 7 Jaap van Netten, M.Sc. Centre for Rehabilitation, University Medical Centre Groningen (UMCG), 9700 RB Groningen, The Netherlands for contributing to the section in Chapter 7 on footwear suitability assessment tools and supplying the recently developed Monitor Orthopaedic Shoes Questionnaire Professor Wesley Vernon, Podiatry Service, Community Health Sheffield, Centenary House, Heritage Park, 55 Albert Terrace Road, Sheffield, S6 3BR, UK for information on footwear ‘wear patterns’ in Chapter 6 C h a p t e r 1 Chapter contents Introduction 1 The foot as a complex Principles of foot structure 2 Terminology for movement and biomechanics position of the foot 3 Motion at the ankle and subtalar joint 6 and gait Motion at the midtarsal and forefoot joints 6 “A thousand miles starts from beneath Medial arch of the foot 7 one’s feet.” The foot and lower limb in gait 7 Lao Tzu Phase 1 of gait 9 Phase 2 of gait 10 Phase 3 of gait 11 Introduction Summary 13 The importance of feet for normal activity and Review questions 14 Reflection 14 function cannot be overstated and it is often Self-assessed questions 14 only when feet go wrong that attention is paid References 14 to them. We do not pay attention to the ability of the foot to adapt to all the different terrains and activities that we take for granted when everything is going well. We rarely think about the distance that it covers: the average person takes approximately 8000 to 10 000 steps per day; and, in a lifetime, walks 115 000 miles, which is the equivalent of four times around the world! The foot is a complex and dynamic mechanism that needs to be understood in its healthy state before we can fully understand the complexity and impact of disease and mal­ function on its ability to function normally.